Q: My father had a massive stroke that left him paralyzed on one side. He s aware of all that s going on and can talk some, but he has severe spasticity in his left elbow, shoulder and hand, along with muscle atrophy. Would Botox injections help the painful spasms in his arm and hand?
A: Botox is a drug derived from botulinum toxin. At high doses, it paralyzes muscles. At lower ones, it relaxes them. It s well-known as a wrinkle reducer. But Botox was originally approved as a treatment for uncontrollable blinking (blepharospasm) and misaligned eyes (strabismus), and it s used for a number of neurological conditions that feature overactive muscles.
Severe damage to one side of the brain, whether from a stroke, trauma, or some other cause, leads to not only weakness on the opposite side of the body but also abnormal muscle tone (spasticity is a type of abnormal muscle tone). Frequently people hold a leg out stiffly, while holding an arm close to the chest with the elbow, wrist, fingers flexed. Daily activities become difficult. Just keeping the arm and hand clean is a problem. Often there s a lot of pain.
Baclofen (Lioresal), a muscle relaxant, isn t very effective. Diazepam (Valium) relaxes muscles but makes people drowsy. So Botox is an exciting new option. The injections relax muscles and relieve pain.
But one drawback of Botox is that it can weaken muscles. For the arm, that is an acceptable risk for many stroke patients, particularly if they re in pain. But the legs are more of a problem because Botox treatments could hamper people s ability to walk.
Another problem is that Botox wears off, so people need injections every couple of months.
I think it would be entirely reasonable for you to talk to your father s doctors about using Botox injections to relieve the pain and spasticity in his arms.
– Dr. Edward R. Wolpow, Mount Auburn Hospital, Cambridge, Mass., Harvard Health Letter Editorial Board
